Provider Demographics
NPI:1821432311
Name:HYODO, LEE, MAGELSEN & YI IV, PLLC
Entity Type:Organization
Organization Name:HYODO, LEE, MAGELSEN & YI IV, PLLC
Other - Org Name:AIRPORT WAY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-355-5233
Mailing Address - Street 1:12121 HIGHWAY 99
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-5516
Mailing Address - Country:US
Mailing Address - Phone:425-355-5233
Mailing Address - Fax:425-353-1314
Practice Address - Street 1:12121 HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-5516
Practice Address - Country:US
Practice Address - Phone:425-355-5233
Practice Address - Fax:425-353-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental